Gynecologic Cancer Center, Department of Obstetrics & Gynecology, CHA University Ilsan Medical Center, Goyang, Korea.
Department of Obstetrics & Gynecology, Korea University College of Medicine, Seoul, Korea.
J Gynecol Oncol. 2020 Jul;31(4):e42. doi: 10.3802/jgo.2020.31.e42. Epub 2019 Dec 20.
Boost radiation using brachytherapy (BT) is a standard treatment for local disease control in concomitant chemoradiation therapy (CCRT) for advanced cervical cancer. However, it is associated with gastrointestinal and genitourinary complications. Hence, this study investigates the feasibility of helical tomotherapy (HT) as an alternative to BT.
Medical records of patients who underwent CCRT between 2000 and 2017 at a single institution were retrospectively reviewed. Patients with stage IIB-IVA cancers were selected based on the 2009 criteria of The International Federation of Gynaecology and Obstetrics. External beam radiation combined with chemotherapy was followed by either BT or HT. The propensity score matching of both groups was calculated using logistic regression analysis. Disease outcomes and treatment-related adverse events were compared between the 2 groups.
The matched population included 70 BT patients and 35 HT patients. The 5-year progression-free survival rates for BT and HT were 72.6% and 72.5%, respectively (p=0.721). There was no difference in the overall survival rate between the two groups (p=0.203). The presence of acute and chronic gastrointestinal complications was also similar between the groups (p=0.460 and p=0.563, respectively). The chronic genitourinary toxicities were also comparable (p=0.105).
HT boost treatment showed comparable disease outcomes with those observed with conventional BT in patients with advanced cervical cancer. HT could be a complementary boost protocol as a single modality or hybrid with BT in selected patients. Further studies with longer follow-up periods are warranted to confirm long-term outcomes.
在同期放化疗（CCRT）中，使用近距离放射治疗（BT）来增强放射治疗是控制局部疾病的标准治疗方法，适用于晚期宫颈癌。然而，它与胃肠道和泌尿生殖系统并发症相关。因此，本研究旨在探讨螺旋断层放疗（HT）作为 BT 的替代方法的可行性。
回顾性分析了 2000 年至 2017 年期间在一家机构接受 CCRT 的患者的病历。根据国际妇产科联合会（FIGO）2009 年的标准，选择了 IIB-IVA 期癌症患者。外照射联合化疗后，患者接受 BT 或 HT 治疗。采用逻辑回归分析计算两组的倾向评分匹配。比较两组之间的疾病结局和与治疗相关的不良事件。
匹配的人群包括 70 名 BT 患者和 35 名 HT 患者。BT 和 HT 的 5 年无进展生存率分别为 72.6%和 72.5%（p=0.721）。两组的总生存率无差异（p=0.203）。两组之间的急性和慢性胃肠道并发症的发生率也相似（p=0.460 和 p=0.563）。慢性泌尿生殖系统毒性也相当（p=0.105）。
在晚期宫颈癌患者中，HT 增强治疗显示出与传统 BT 相似的疾病结局。HT 可以作为一种单独的模式或与 BT 联合应用于特定患者的补充增强方案。需要进行随访时间更长的进一步研究来确认长期结果。
